The mission of the University of Miami Sickle Cell Center is to provide state-of-the-art care to children and adults with sickle cell disease in South Florida within a psychosocially-sensitive environment, and supported by clinical research. Children with sickle cell disease are at risk for a variety of central nervous system (CMS) complications, including overt clinical stroke, silent infarction, increased cerebral blood flow rates, and possibly microvascular infarction not grossly detected by neuroimaging. These CMS events affect neuropsychological performance and academic achievement. Children who experience CMS injury because of SCO are also at higher risk for behavior and adjustment challenges, although behavior problems are also associated with higher family conflict. Family conflict has been identified as a significant stressor, and associated with more difficulty dealing with sickle cell disease symptoms, particularly pain. A biopsychosocial model of SCO suggests that these factors may be interrelated, and implementing positive change in one area will possibly benefit the other areas of function. The proposed project has three specific aims (1) evaluate the effect of an intervention that provides educational support for parents to improve academic achievement in children with SCO at risk for CMS impairment. We will accomplish this aim by recruiting a cohort of children with HbSS or HbSjff-thal SCO, evaluating their neurocognitive function, randomly assigning them to receive either low-intensity (Annual Parent Intervention {API}) or high intensity (Quarterly Parent Intervention {QPI}) parent educational support, and then repeating evaluation of academic achievement annually for three years;(2) Evaluate the effect of the intensity of the parent intervention on non-academic factors of behavioral adjustment of the children, parenting stress, family conflict, and frequency of pain significant enough to disrupt function and interfere with school attendance;and (3) explore the relationship between academic achievement, behavioral adjustment, parenting stress and family conflict, and pain frequency. We will accomplish this aim by exploring the propsed relationship between these factors. This goal of this project is take the biopsychosocial-developmental model in a new direction-one that will provide empirical data for a supportive psychoeducational intervention with children with sickle cell disease and their families in order to improve academic outcomes.